Search WWW Search care4lupus.blogspot.com

Have you seen a rheumatologist lately?

Tuesday, March 25, 2008

What is the topic?

Although a number of studies have found that specialty care is associated with improved outcomes, there are reports that certain groups of lupus patients -- especially the elderly and African American women often do not have even annual visits with a rheumatologist. That may contribute, in part, to the more severe manifestations of disease seen in African Americans with lupus. Little is known about the use of rheumatology services by other groups of lupus patients (e.g., younger patients, other ethnic minority group members) or how the use of specialists relates to the type of medical insurance a lupus patient may or may not have.

What did the researchers hope to learn?

The researchers wanted to examine the socioeconomic and/or demographic factors that might affect lupus patients’ use of rheumatology physician services. The primary outcome was whether or not patients had seen a rheumatologist at least once in the prior 12 months. The researchers also sought to determine what kind of physicians (e.g., family practice physicians, internists, rheumatologists, other specialists) were primarily responsible for managing lupus patients’ care.

Who was studied?

The participants in this study were already part of the Lupus Outcomes Study (LOS), which has been following nearly 1,000 English-speaking patients with lupus over a number of years. This study included 867 people with lupus, more than 91% of whom were women. The racial/ethnic backgrounds of the study participants, as self-identified by the subjects, were: Caucasian (69%), Hispanic/Latino (11%), African American (8%), Asian/Pacific Islander (10%), and some other race/ethnicity (2%).

How was the study conducted?

Trained survey workers conducted hour-long telephone interviews with the study participants. They collected data on age, sex, disease status, race/ethnicity, income, education, type of health insurance, and how they had come to participate in the LOS (either through a referral from a rheumatology practice or community outreach). The results were analyzed to weigh the relative impact of different variables.

What did the researchers find?

The researchers found that older participants, males, and those with lower incomes were less likely to visit a rheumatologist, even after taking other variables into account such as race/ethnicity, health insurance, and disease status. They guessed that this underuse of rheumatology services was probably caused by barriers to accessing care, such as lack of rheumatologists nearby, lack of awareness of rheumatology expertise, less frequent referrals to rheumatologists, or inadequate follow-up by rheumatologists once care is established.
The researchers did not find a discrepancy in specialty care use by race/ ethnicity in this study, a finding that contrasted with a prior study that showed African Americans with lupus had significantly fewer rheumatology visits compared with Caucasians.

What were the limitations of the study?

The participants in this study were not randomly selected, but rather had already been enrolled in the LOS. It is possible that the respondents may have had increased access to care compared to lupus patients in general; in particular, study participants identified as members of ethnic/racial minorities were more likely to have been recruited for the original study from rheumatology practices. Also, the study relied on self-reported medical histories, which are not as reliable as detailed clinical information, and this could have masked important differences about the severity of disease in the different groups.

What do the results mean for you?

The study results point to the need for greater access to rheumatology specialty care for particular groups of lupus patients. In many patients, lupus symptoms may become less severe as they grow older, and this may account in part for why older lupus patients are less likely to see a rheumatologist. However, this is not true for all patients, and some of these patients may still need the particular expertise of physicians who have special training in the management of lupus.

source

Labels: demographic, socioeconomic, systemic lupus erythematosus, utilization of rheumatology subspecialty

Blogged on 7:21 PM

|

~~~

Particular immune molecules and NPSLE

What is the topic?

Despite the fact that a significant percentage of lupus patients (estimates run from 14% to 75%) have signs of neurological involvement, doctors still don’t have a single test that can definitely indicate when lupus is affecting the central nervous system (NPSLE).

What did the researchers hope to learn?

The researchers sought to determine if the presence of particular factors in the spinal fluid (CSF) of lupus patients are associated with NPSLE, which might help determine NPSLE diagnosis.

Who was studied?

The study had four different groups of subjects who were patients at the same hospital in Mexico City: 42 lupus patients who had symptoms of NPSLE; six lupus patients with septic meningitis; 16 lupus patients with no symptoms of NPSLE; and 25 patients with no autoimmune disease and no neurological manifestations who were undergoing elective surgery.

How was the study conducted?

All of the patients agreed to participate in the study and to undergo a spinal tap. Six months after hospitalization, a second spinal tap was done on 30 of the 42 NPSLE patients.
The researchers compared the CSF samples of the NPSLE patients with those of the other groups They also compared the samples of the NPSLE patients that were taken six months later, after the patients had undergone medical treatment and no longer had any NPSLE symptoms.

What did the researchers find?

The researchers found increased concentrations of several inflammatory proteins in the CSF of lupus patients during a flare of NPSLE including interleukin 6 (IL-6) and several other proteins. At the six-month follow-up, levels of these inflammatory proteins had decreased significantly, but not completely, and were now similar to lupus patients who did not have NPSLE.
What were the limitations of the study?The researchers did not study any group of patients with neurologic symptoms but no autoimmune disease, so it is impossible to determine if the high levels of the compounds they identified were present because of the NPSLE or the general fact that there was neurological involvement.

What do the results mean for you?

Though further studies are required, this research does suggest a particular blood test that could be useful in determining when lupus involves the nervous system. It also provides an interesting perspective on the different ways lupus can affect tissues and cells depending on where they are located in the body and the functions they perform.

source

Labels: chemokines, Interleukin-6, neuropsychiatric, NPSLE, systemic lupus erythematosus

Blogged on 7:16 PM

|

~~~

Medication use and infertility in men with lupus

What is the topic?

Because lupus can affect almost every organ system in the body, men who develop lupus may have concerns about their fertility, especially since the presence of antisperm antibodies has been observed in a significant percentage of lupus patients.

What did the researchers hope to learn?

The researchers sought to determine the frequency and possible causes of sperm damage in men with lupus.

Who was studied?

The researchers studied sperm development and sexual function in 35 males diagnosed with lupus and 35 healthy males.

How was the study conducted?

Each of the study participants underwent an examination by a urologist. Sperm samples were obtained to compare sperm count, shape, and motility (the ability of the sperm to move) between the two groups. The lupus patients also had their sex hormone levels determined, their medical histories collected (including data on the duration and dosages of medications they had taken for lupus), and their sperm samples tested for antisperm antibodies.

What did the researchers find?

The researchers found a high frequency of sperm abnormalities in men with lupus, including lower sperm counts and reduced sperm mobility. Both of these conditions are linked to male infertility. They also noted that the volume of the testes of the men with lupus was reduced compared to the controls. Their analysis showed, however, that these sperm and testicular abnormalities were not the result of lupus disease activity but stemmed from prolonged use (more than five years) of the immunosuppressant drug cyclophosphamide (CYC, trade name, Cytoxan®).

What were the limitations of the study?

Though the researchers showed that sperm abnormalities occurred much more frequently in males with lupus, the researchers were unable to predict which patients might become infertile.
What do the results mean for you?It is already known that CYC is associated with infertility. This research confirms the possibility of infertility among men with lupus who receive CYC therapy. Men with lupus who must receive this treatment may want to consider freezing sperm samples first.

source

Labels: Gonad evaluation, infertility, male, systemic lupus erythematosus

Blogged on 7:11 PM

|

~~~